Vera Georgievna Selyatitskaya

Background . The prevalence of chronic tonsil diseases is constantly increasing among children of different ages. To date, the treatment of pediatric patients with chronic diseases of the upper respiratory tract remains controversial and requires new therapeutic approaches. Aim . To study the clinical and anamnestic characteristics of chronic adenoiditis in children aged 3-6 years and to evaluate the effectiveness of including a probiotic drug in postoperative rehabilitation. Methods. A total of 100 children aged 3–6 years with chronic inflammatory processes of the nasopharynx were examined. The patients were divided into 2 comparable groups, depending on the treatment and rehabilitation measures received. A parent survey was conducted to assess the severity of clinical symptoms before treatment and 30 days after adenotomy. Results. The frequency and duration of viral infections in children with chronic adenoiditis were assessed. Before surgery, 62 % of children had acute respiratory infections (ARIs) once every 2 months or more, and 62 % had ARI episodes lasting more than 7 days. According to the survey results, after treatment there was a statistically significant decrease in the frequency of the following symptoms in children in both study groups: difficulty in nasal breathing, snoring, cough, and bad breath. In the main group, there was a marked decrease in the intensity of nasal breathing difficulty (by 84 %) and in the frequency of sleep disorders (by 58 %) after probiotic treatment. Conclusion . The post-treatment survey data demonstrate regression of clinical symptoms in both groups. However, with respect to symptoms such as decreased intensity of nasal breathing and reduced frequency of sleep disorders, higher therapeutic efficacy was observed when a probiotic was used as an adjunct to adenotomy.

Among the main pathologies of childhood, respiratory tract lesions dominate, with a significant proportion of this category of diseases being chronic inflammatory processes localized mainly in the pharyngeal tonsil (adenoids) and palatine tonsils. Due to the prevalence of these pathologies, it is necessary to develop new approaches to the treatment and rehabilitation of patients. The aim of the study was to conduct a study of the microbiome of the upper respiratory tract and gastrointestinal tract in paediatric patients with chronic adenoiditis for a comparative analysis of the clinical effectiveness of various treatment approaches. Material and methods . We checked out 150 kids aged 3-6 years with chronic inflammation in their nasopharynx. We split the patients into 3 comparable groups based on the treatment and rehabilitation measures carried out. Group 1 included patients who underwent surgery under general anesthesia. Children in groups 2 and 3 received nasopharyngeal irrigation with a probiotic solution for 30 days after surgery or without surgery, respectively. All children underwent bacteriological testing of the oral and nasopharyngeal microbiome, as well as qualitative and quantitative analysis of the luminal intestinal microflora. Results and discussion . In groups 2 and 3, after treatment, the number of cultures positive for Streptococcus salivarius (by 20 and 28 %, respectively), S. mitis (by 14 and 18 %, respectively) in washings from the mouth and nasopharynx statistically significantly increased, in group 3 − cultures containing Neisseria spp. and S. oralis (by 38 and 20 %, respectively). In groups 2 and 3, a decrease in the number of transient and accessory microflora, including Staphylococcus aureus and S. pyogenes , was detected. The composition of the intestinal microbiome significantly improved: in groups 2 and 3 normal microflora was determined in 94.0 % of patients in group 2 (before treatment – only in 8 %) and in 96.0 % of children in group 3 (before treatment – in 16 %). Conclusions. The data obtained indicate the significant effectiveness of probiotic therapy in the postoperative period, as well as in combination with conventional conservative treatment methods for the correction of the microflora of the upper respiratory tract and intestinal biocenosis in children with chronic infectious and inflammatory processes of the nasopharynx.

Introduction. The male factor plays a significant role in couple infertility. However, the efficacy of traditionally used vitamin–mineral complexes and antioxidants in the management of pathospermia remains uncertain. Oxidized dextran is considered a promising agent for improving semen parameters due to its multimodal mechanism of action. Aim of the research. To perform a comparative analysis of the effectiveness of oxidized dextran and a vitamin-mineral complex in the correction of pathospermia in men with impaired fertility. Materials and methods. A prospective comparative study was carried out involving 96 men with pathospermia from infertile couples. Patients were divided into two groups: a group of men receiving preparations with oxidized dextran (OD) to improve ejaculate parameters (Group 1; n = 48; OD suppositories + OD capsules, 3 months) and a group of men receiving a vitamin and mineral complex (VMC) to improve ejaculate parameters (Group 2; n = 48; standard vitamin and mineral complex, 3 months). Spermogram parameters were assessed before and after 3 months of treatment. Statistical analysis was performed using the paired Student’s t-test or the Wilcoxon signed-rank test, depending on the normality of the distribution of differences (Shapiro-Wilk test). For binary parameters, the McNemar test was used. Results. In the group of patients receiving OD, after 3 months, there was a statistically significant improvement in sperm concentration (median 28.5 → 44.2 million/ml; p < 0.001), total count (87.5 → 132.8 million; p = 0.002), progressive motility (27.0 → 35.0%; p = 0.004), a decrease in the proportion of immotile forms (45.5 → 40.5%; p = 0.032), improvement in morphology according to Kruger strict criteria (p = 0.001) and viability (p = 0.016). In the group of patients receiving VMC, none of the analyzed parameters demonstrated statistically significant changes (all p > 0.05). Conclusion. Oxidized dextran therapy is superior to vitamin and mineral supplementation in its impact on key ejaculate parameters. These results support the use of oxidized dextran-based medications as initial therapy to improve ejaculate parameters and restore male reproductive function.

Introduction. The specific arrangement of circadian rhythms of physiological functions inherent to a given individual, referred to as chronotype, is determined not only by the alternation of cycles of rest and activity but also by the characteristics of eating behavior. However, aspects concerning the correlations between chronotype and food preferences, diet volume and contents in adults remain insufficiently studied, in particular, how chronotype is linked to the mechanisms that maintain glucose levels in the body. Aim. Analysis of glycemic variability (GV) parameters in men with different chronotypes while maintaining their regular diet. Materials and methods. The study included 43 male volunteers aged 25–65 years. The Horne and Östberg Morningness-Eveningness Questionnaire was used to determine the chronotype. The nature and severity of eating behavior (EB) disorders were assessed using the Dutch Eating Behavior Questionnaire (DEBQ). The severity of anxiety and depressive symptoms was assessed using the Hospital Anxiety and Depression Scale (HADS). Glucose levels were continuously monitored for 5–6 days, with data from two full days, during which the research subjects maintained their regular diet, were used for interpretation. Results. The distribution of chronotypes within the sample was as follows: 51,2% of participants had morning chronotype, 25,6% – intermediate chronotype, and 23,3% – evening chronotype. Men with evening chronotype had statistically significantly higher emotional EB scores than those with morning and intermediate chronotypes. Meanwhile, the severity of external EB in those with evening chronotype was significantly lower than in the other two groups. A comparative assessment of the parameters and indices reflecting GV during the day and night hours showed that men with the morning and evening chronotypes differed significantly from those with intermediate chronotype across a number of criteria. Specifically, intermediate chronotype was characterized by statistically significantly lower values of the mean glucose concentration, standard deviation of glycemia, CONGA, and J-index. The values of the parameters of GV characterizing GV during the night hours also showed significant differences between the intermediate chronotype group and the morning and evening chronotype groups. Conclusion. Personal chronotype is one of the factors determining the specific regulatory mechanisms of carbohydrate metabolism. Therefore, this characteristic must be taken into account when stratifying the risk of type 2 diabetes, which, according to the data obtained in this study, increases in the following sequence of chronotypes: intermediate type → morning type → evening type.

The problem of comorbidity is of great importance due to its severe medical and social consequences. In the etiopathogenesis of comorbid pathology in patients with somatic disease, a significant role is played by risk factors that tend to appear in the form of clusters. Aim of the study was to investigate the features of the severity and structure of comorbidity in patients with a therapeutic profile in the presence of each of the three clusters of risk factors for chronic non-communicable diseases (cluster 1: age over 52 years, obesity, hyperglycemia; cluster 2: arterial hypertension, hypertriglyceridemia, elevated serum concentration of C-reactive protein (CRP), hyperuricemia; cluster 3: low(LDL) and high-density lipoprotein (HDL) hypocholesterolemia).Material and methods. The study included data from case histories of 4908 people, 2026 men (41.3 %) and 2882 women (58.7 %), aged 57.9 ± 0.2 years (arithmetic mean ± standard error of the mean). Three groups of patients were formed depending on the presence of a particular cluster of risk factors: Group 1 – age over 52 years, obesity, hyperglycemia (n = 434); Group 2 – arterial hypertension, hypertriglyceridemia, elevated serum concentration of CRP, hyperuricemia (n = 108); Group 3 – LDL hypercholesterolemia, HDL hypocholesterolemia (n = 363). The frequency of all available nosological forms was analyzed in accordance with ICD-10. Transnosological comorbidity was assessed by the number of nosological forms, transsystemic comorbidity – by the number of ICD-10 classes in one patient.Results and discussion. A high level of transsystemic and transnosological comorbidity was revealed in patients with any of the considered clusters, which emphasizes their importance in the development of comorbidity. The highest comorbidity rates were found in patients with a cluster of factors: age over 52 years, obesity and hyperglycemia (transnosological comorbidity – 8.86 ± 0.19; transsystemic comorbidity – 4.60 ± 0.06). The most common nosologies in patients in all 3 groups were hypertension, deforming dorsopathy and non-alcoholic fatty liver disease, which may be due to the common pathogenetic mechanisms of these diseases (dysregulatory, vascular and metabolic disorders), which can be initiated by the considered risk factors.Conclusions. Among the clusters of factors associated with comorbidity, the most significant are the following: age over 52 years, obesity, hyperglycemia; arterial hypertension, hypertriglyceridemia, hyperuricemia, increased serum concentration of CRP.

Introduction. Tuberculosis is among the most common infectious diseases in humans. One of the main drugs for treating tuberculosis, isoniazid, has a wide range of adverse effects, including hepatotoxicity, making the search for ways to reduce its toxic reactions highly relevant. The aim of the study was to assess liver damage, as well as the levels of the cytokines IL-6 and TNF-α, metalloproteinases MMP1 and MMP9, and the protease inhibitor TIMP-1 in mice with BCG granulomatosis. These factors were evaluated immunohistochemically following intraperitoneal injection of isoniazid, dextrazide, or a liposomal form of dextrazide (LFD), along with its inhalational injection. Methods. Fifty male BALB/c mice were infected with BCG vaccine via retroorbital route. After 3 months, isoniazid or its compositions with oxidized dextran were injection twice a week at a dose of 14 mg/kg body weight for 2 months; the control group received NaCl solution. Liver was followed by histological processing and immunohistochemistry. Results. Tuberculosis granulomas were detected in the liver 5 months after infection. The total number of granulomas was reduced in mice receiving all forms of isoniazid, but LFD injection by inhalation was the most effective. The volume densities of lymphoid infiltrates and tissue damage were greatest in the livers of mice injected with NaCl, with lower values observed in the isoniazid-treated groups. The number of cells producing IL-6, MMP1, and MMP9 was highest in the isoniazid group, while TNF-α production was highest in the NaCl group. The lowest values for these parameters were observed in mice treated with LFD. The number of cells producing TIMP1 was highest in the groups receiving LFD. Conclusion. Two months after starting the isoniazid treatments, the amount of mycobacterium tuberculosis (MBT) in the liver decreased, particularly with the inhalational injection of LFD. This suggests that LFD helps modulate the inflammatory response in tissues and reduces damage, likely due to the systemic anti-inflammatory effect of oxidized dextran in the LFD.

   The aim of this study was to conduct a comparative analysis of the development of obesity in rats fed a high-fat diet (HDL) for 4 and 7 weeks.   Material and methods. Sexually mature male Wistar rats were used in the work. Control animals were kept on a diet in which fat was 10–11 %, experimental rats – on an HDL, in which fat accounted for 36 % of the caloric content of the daily diet due to the addition of melted pork fat to the food. The mass of organs and adipose tissue, the content of triglycerides, total and cholesterol, high- and low-density lipoproteins, and the activity of alanine and aspartate amino transferase in blood serum were measured. Liver sections were stained with hematoxylin and eosin to assess the relative number of Kupffer cells. An indirect streptavidin peroxidase method was used for immunohistochemical examination of sections.   Results and discussion. In rats kept on HDL for 4 weeks, the following parameters increased in comparison with control animals: body weight by 21 %, mass index of retroperitoneal, epidermal and interscapular brown fat (by 56, 33 and 52 %, respectively), serum triglyceride content by 2.3 times, numerical density of Kupffer cells by 2.1 times, the expression of matrix metalloproteinase 9 in the liver by 2.8 times. After 7 weeks of HDL, alanine amino transferase activity in serum increased by 20 %, the numerical density of Kupffer cells remained 2.1-fold increased, and the expression level of matrix metalloproteinase 9 raised 5-fold relative to control rats.   Conclusions. After 4 weeks of HDL treatment, the rats developed an obesity phenotype, accompanied by negative shifts in the structural and functional state of the liver; after 7 weeks, these negative changes worsened, which allows us to consider the used model of obesity in rats as a tool for studying the effectiveness of approaches to normalizing obesity and related diseases.

The study of the viability of the spermatogenic epithelium in case of toxic lesions and their correction in experiment is a key factor for understanding the possibilities of restoring reproductive function in conditions of increasing technogenic pollution. The purpose of the study was to evaluate the level of pathomorphological changes in the testes of Wistar rats and the intensity of steroidogenesis upon administration of Escherichia coli lipopolysaccharide (LPS) endotoxin and subsequent correction of intoxication by administration of oxidized dextran. Material and methods. Three groups of Wistar rats were formed, intraperitoneal administration: 2 ml of 0.9 % NaCl solution (n = 5, control); E. coli LPS at a dose of 50 μg/kg body weight (n = 5); E. coli LPS at the same dose, followed by the introduction of 2 ml of a 2 % solution of oxidized dextran (OD) (n = 5). The content of testosterone in the blood serum and pathomorphological changes in the testes were assessed. Results and discussion. The administration of LPS led to moderate hypotrophy of the spermatogenic epithelium due to a decrease in the numerical density of spermatocytes and spermatogonia (by 22.4 and 26.6 %, respectively); a decrease in the numerical density of Leydig cells by 14.5 % and testosterone levels by 2.3 times (in 80 % of animals, testosterone levels ranged from 4.3 to 2.0 nmol/l). The injection of OD after LPS caused an increase in seminiferous tubule diameter and the spermatogenic epithelium height (by 2,9 и 3,3 %, respectively), in numerical density of spermatocytes and spermatogonia (by 16.8 and 14.6 %, respectively) compared to LPS; increase in the ratio of the number of spermatocytes to spermatogonia (by 6.8 %) compared to the control. The numerical density of Leydig cells increased by 4 %, the testosterone level increased by 1.7 times (in 60 % of animals the testosterone level varied from 12.7 to 37.3 nmol/l) compared to LPS. Conclusions. A single administration of OD after acute exposure to E. coli LPS endotoxin initiated the onset of restoration of the histological structure of the spermatogenic epithelium of the seminiferous tubules.

Aim of the study was to quantify postprandial glucose levels in response to isocaloric protein load at main meals in men with different types of fat distribution. Material and methods. The study enrolled men aged 25 to 65 years. Group 1 (n = 17) consisted of obese men with subcutaneous fat distribution (SFD) type while group 2 (n = 16) was represented by obese men with abdominal type of fat distribution (AFD). Group 3 (comparators) consisted of 10 men with normal body weight (NBW). Glycemic response to standard isocaloric protein load was assessed by the results of glucose levels within 3 hours starting 5 minutes after end of food consumption on different days and mealtime. Standard protein lunch was introduced during the second day while standard protein dinner and breakfast were performed at the third and fourth days respectively. Results. It was found that protein intake leads to neither pronounced postprandial glycemic fluctuations nor decrease in glucose levels by the end of the 3rd hour of the test. Accordingly, it also doesn’t provoke hunger, unlike carbohydrate intake does. In men with NBW a more pronounced increase in glucose level after protein meal was found, both relative to the baseline levels and comparing with men from SFD and AFD groups. In NBW group at lunchtime and especially in the evening a double-humped glycemic curve was noted. Glycemic variability in men with different types of fat distribution was characterized by the fact that glycemic increment was more pronounced in men with AFD than in men with SFD whose glycemic curve was almost flat after all meals. Conclusions. Protein intake in men with NBW and different types of fat distribution does not lead to significant changes in postprandial glucose levels. Glycemic fluctuations don’t exceed 1 mmol/L within a 3-hour period after consuming of isocaloric breakfast, lunch or dinner. Protein intake results in greater postprandial glucose levels in men with AFD than in SFD men.

In men from infertile couples the serum level of total testosterone (tT) has been shown to vary widely. Is it possible to expect that there is an association of tT content with spermogram disorders in men from infertile couples? Aim of the study was to investigate the patterns of changes in the spermiological status of men from infertile couples depending on tT level in blood serum. Material and methods. Design – observational, retrospective, one-stage study. The analysis of medical histories of 358 men with infertility in marriage was carried out. The sample was divided into comparison groups according to tT level: group 1 – less than 12.1, group 2 – from 12.1 to 20.9, group 3 – 21.0 nmol/l or more. Results. From group 1 to group 3, tT content increases more than twice, as well as concentration of indicators related to the level of T – sex hormone binding globulin (SHBG) and free testosterone (fT). There are no significant differences in luteinizing hormone (LH) and follicle stimulating hormone (FSH) level, although there is a tendency to its increase from group 1 to group 3. From group 1 of men with androgen deficiency to group 3, not only body weight and body mass index (BMI), but also waist circumference (WC) and hip circumference (HC), as well as the WC/HC index, characterizing the degree of abdominal obesity, decrease. The groups examined did not differ in the values of all studied ejaculate parameters. In group 1, a pronounced correlation between the content of tT and fT was found, in groups 2 and 3 – statistically significant inverse relationships between the level of Tob and the values of anthropometric indicators (body weight, BMI, WC and HC), as well as direct ones - with the concentration of SHBG, tT, LH and estradiol, in group 3 – with FSH levels. There were no correlations between tT content and spermogram indicators in any group of examined men. Conclusions. The results obtained suggest that only at high-normal level of testosterone in the blood it can have a stimulating effect on spermatogenesis. As a result of the accumulation of cases of androgenic deficiency in the population, the direct positive effect of serum testosterone on spermatogenesis is becomes insufficient for normal regulation, and the negative effect of testosterone deficiency on spermatogenesis, mediated through the accumulation of overweight and obesity comes to the fore.